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Barquet-Muñoz SA, Arteaga-Gómez C, Díaz-López E, Rodríguez-Trejo A, Marquez-Acosta J, Aranda-Flores C. Current status and challenges in timely detection of cervical cancer in Mexico: expert consensus. Front Oncol 2024; 14:1383105. [PMID: 38606102 PMCID: PMC11007212 DOI: 10.3389/fonc.2024.1383105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Cervical cancer is a significant public health problem in low- and middle-income countries, accounting for 85% of new cases worldwide. Due to poorly organized screening programs, cervical cancer is more likely to develop in vulnerable groups who do not initiate or rarely undergo screening. Cervical cytology and detecting high-risk human papillomavirus types are the recommended screening tools. Further, these strategies allow for accurately identifying women at a higher risk of cervical cancer and establishing screening times. New detection tools, such as novel biomarkers or automatic HPV detection in the vagina or urine, can improve screening coverage. This review aims to identify the challenges faced by detection programs and screening tools in Mexico to provide evidence-based recommendations to improve early detection programs for cervical cancer.
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Affiliation(s)
| | | | - Elsa Díaz-López
- Colegio Mexicano de Especialistas en Ginecología y Obstetricia, Mexico City, Mexico
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Terasawa T, Hosono S, Sasaki S, Hoshi K, Hamashima Y, Katayama T, Hamashima C. Comparative accuracy of cervical cancer screening strategies in healthy asymptomatic women: a systematic review and network meta-analysis. Sci Rep 2022; 12:94. [PMID: 34997127 PMCID: PMC8741996 DOI: 10.1038/s41598-021-04201-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/17/2021] [Indexed: 02/01/2023] Open
Abstract
To compare all available accuracy data on screening strategies for identifying cervical intraepithelial neoplasia grade ≥ 2 in healthy asymptomatic women, we performed a systematic review and network meta-analysis. MEDLINE and EMBASE were searched up to October 2020 for paired-design studies of cytology and testing for high-risk genotypes of human papillomavirus (hrHPV). The methods used included a duplicate assessment of eligibility, double extraction of quantitative data, validity assessment, random-effects network meta-analysis of test accuracy, and GRADE rating. Twenty-seven prospective studies (185,269 subjects) were included. The combination of cytology (atypical squamous cells of undetermined significance or higher grades) and hrHPV testing (excepting genotyping for HPV 16 or 18 [HPV16/18]) with the either-positive criterion (OR rule) was the most sensitive/least specific, whereas the same combination with the both-positive criterion (AND rule) was the most specific/least sensitive. Compared with standalone cytology, non-HPV16/18 hrHPV assays were more sensitive/less specific. Two algorithms proposed for primary cytological testing or primary hrHPV testing were ranked in the middle as more sensitive/less specific than standalone cytology and the AND rule combinations but more specific/less sensitive than standalone hrHPV testing and the OR rule combination. Further research is needed to assess these results in population-relevant outcomes at the program level.
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Affiliation(s)
- Teruhiko Terasawa
- Section of General Internal Medicine, Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan.
| | - Satoyo Hosono
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, Tokyo, Japan
| | - Seiju Sasaki
- Center for Preventive Medicine, St. Luke's International Hospital Affiliated Clinic, Tokyo, Japan
| | - Keika Hoshi
- Center for Public Health Informatics, National Institute of Public Health, Wako, Japan
| | - Yuri Hamashima
- Department of Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Takafumi Katayama
- Department of Statistics and Computer Science, College of Nursing Art and Science, University of Hyogo, Hyogo, Japan
| | - Chisato Hamashima
- Department of Nursing, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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3
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Sato M, Shintani D, Hanaoka M, Sato S, Miwa M, Ogasawara A, Yabuno A, Kurosaki A, Yoshida H, Fujiwara K, Hasegawa K. A pilot study of mobile digital colposcopy in Japanese patients with cervical intraepithelial neoplasm. Mol Clin Oncol 2021; 15:207. [PMID: 34462663 PMCID: PMC8375023 DOI: 10.3892/mco.2021.2370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/11/2021] [Indexed: 11/21/2022] Open
Abstract
Digital colposcopy built around a smartphone is becoming common, and this has advantages for telemedicine and data sharing by taking advantage of smartphone characteristics. However, digital colposcopy itself is not allowed in clinical practice in Japan. The aim of the present study was to investigate the feasibility of mobile digital colposcopy incorporating a smartphone for management of cervical screening in Japanese patients. Patients who underwent colposcopy at Saitama Medical University International Medical Center between July 2019 and February 2020 were enrolled in the present study. The inclusion criteria were women aged 21-65 years old referred for colposcopy following the Japanese standard of care. Written informed consent was obtained from all patients. A total of 40 patients (52 tests) were included in the study. Following the standard of care, acetic acid was applied to the cervix, which was then visualized using a traditional colposcope, with biopsies collected as necessary. The cervix was then visualized and an imaged was captured using a mobile digital colposcope incorporating a smartphone (EVA System; Mobile ODT). All images were collected before biopsy. Images were stored on a secure cloud portal for subsequent evaluation by the provider who performed the conventional colposcopy, and the diagnoses were compared. The present study was approved by the Institutional Review Board of Saitama Medical University International Medical Center (Hidaka, Japan). The match rates for diagnoses were 75%. The match rates for the actual (from conventional colposcopy) and assumed (from digital colposcopy) biopsy sites were 61, 16 and 23%, based on definitions of the ‘same’, ‘almost the same’ and ‘different’, respectively. The present results indicated that ≥75% cases were equivalent in digital colposcopy and conventional colposcopy. This suggests that digital colposcopy may not be inferior to conventional colposcopy.
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Affiliation(s)
- Masakazu Sato
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Daisuke Shintani
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Mieko Hanaoka
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Sho Sato
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Maiko Miwa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Aiko Ogasawara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Akira Yabuno
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Akira Kurosaki
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Hiroyuki Yoshida
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
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Tom JJ, Vaz C, Nisha C. Screening for cervical dysplasia and reproductive tract infections in Kerala, India: A multicentric study. J Family Med Prim Care 2020; 9:4107-4111. [PMID: 33110817 PMCID: PMC7586590 DOI: 10.4103/jfmpc.jfmpc_514_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/25/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Cancer of the uterine cervix is estimated to the second most frequently occurring malignancy among females in India. Cancer mortality profile in India estimates that 20.7% of cancer deaths in females are cervical cancer. This well elucidates the fatal aspect of the disease and the need for early detection. Aims: To screen for cervical dysplasias and reproductive tract infections in various parts of Kerala, India, and determine its associated factors. Methods and Methodology: This was a descriptive cross-sectional study conducted in various parts of Kerala, India. This study included an interview schedule to collect data and the procedures included per speculum examination along with a Pap smear test. Results: A total of 199 women were screened with mean age of 45.87 ± 9.84 years. Of these, 13.5% showed inflammatory smears, 1% showed infective pathology and 1.5% showed pre-malignant lesions. Conclusion: The increased rates of inflammation and infection show its importance in public health. Similar community-based screening as well as routine screening by physicians/gynaecologists is recommended for early detection of cervical cancer and reproductive tract infections. Community education among the population proves to be an important factor; especially regarding HPV vaccination.
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Affiliation(s)
- Jeremiah Jacob Tom
- Department of Community Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Clint Vaz
- Department of Clinical Immunology and Rheumatology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.,Current status: Chief Medical Officer, St. Joseph's Hospital, Thrissur, Kerala, India
| | - Catherin Nisha
- Department of Community Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India
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Kannan A, Kiyam W, Bupesh G, Bhaskar M, Prasaad PR, Rao B. Comparative analyses of PAP smear data in pre and postmenopause Indian women. Bioinformation 2020; 16:452-457. [PMID: 32884208 PMCID: PMC7452747 DOI: 10.6026/97320630016452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/19/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
PAP smear is one of the best screening tools available for early detection of cervical cancer. Hence, we conducted a retrospective study at the Department of Pathology, Sree Balaji Medical College and Hospital over a period of one year by collecting PAP smear data. A total of 978 smears were collected out of which 59% were premenopausal and 41% were post menopausal women. Data shows that the prevalence of pre malignant and malignant lesions were more among the women of post menopausal age group than the pre menopausal age group.
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Affiliation(s)
- Anbumozhi Kannan
- Department of Pathology, Sree Balaji Medical College and Hospital (SBMCH), BIHER, Chrompet, Chennai - 600044, India
| | - Wangol Kiyam
- Department of Pathology, Sree Balaji Medical College and Hospital (SBMCH), BIHER, Chrompet, Chennai - 600044, India
| | - Giridharan Bupesh
- Research and Development Wing, Central Research Laboratory, Sree Balaji Medical College and Hospital (SBMCH), BIHER, Chrompet, Chennai - 600044, India
| | - Matcha Bhaskar
- Department of Zoology, Sri Venkadeswara University, Tirupathi, India
| | - Priavadhana Rajan Prasaad
- Department of Pathology, Sree Balaji Medical College and Hospital (SBMCH), BIHER, Chrompet, Chennai - 600044, India
| | - Bheema Rao
- Department of Pathology, Sree Balaji Medical College and Hospital (SBMCH), BIHER, Chrompet, Chennai - 600044, India
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Gupta P, Gupta N, Rajwanshi A, Dey P. Role of fractal dimension in distinguishing benign from malignant endometrial clusters in liquid-based cervical samples. Cytopathology 2020; 31:451-456. [PMID: 32246882 DOI: 10.1111/cyt.12826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/08/2020] [Accepted: 03/21/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Exfoliated endometrial cells are often seen as hyperchromatic crowded groups (HCGs) in cervical samples. It is challenging for the cytopathologists to discriminate between HCGs of benign and malignant endometrial cells. Fractal dimension (FD) analysis has proved to be a useful tool in discriminating between different types of cell groups in previous studies. AIMS This study was conducted to evaluate the utility of FD for differentiating between benign and malignant endometrial HCGs, in liquid-based cervical samples. METHODS Two groups of cervical samples, with subsequent histopathology, were selected: Group A: 30 cases with benign endometrial HCGs; and Group B: 39 cases with malignant endometrial HCGs. Image J, NIH and FracLac software were used for selecting and measuring the FD of the HCGs. Student t-test was used for statistical analysis. RESULTS The mean FD for benign endometrial HCGs (1.066943 ± 0.0699) was significantly lower than that of the malignant endometrial HCGs (1.086271 ± 0.05121; P = .001). Using receiver operator characteristic curve analysis, we determined that an FD cut-off value of 1.01 would yield sensitivity of 90.3%, specificity of 26.1%, positive predictive value of 47.3% and negative predictive value of 78.6%. CONCLUSION The measurement of FD of HCGs in cervical samples can serve as a useful screening adjunct to differentiate malignant from benign HCGs, owing to its high sensitivity. However, in view of its low specificity and positive predictive value, we recommend that cases labelled as malignant by the FD value be confirmed for malignancy by other methods.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Nkfusai NC, Cumber SN, Anchang-Kimbi JK, Nji KE, Shirinde J, Anong ND. Assessment of the current state of knowledge and risk factors of cervical cancer among women in the Buea Health District, Cameroon. Pan Afr Med J 2019; 33:38. [PMID: 31384353 PMCID: PMC6661163 DOI: 10.11604/pamj.2019.33.38.16767] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/19/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Cervical cancer is a malignant proliferation of the cells of the uterine cervix and can be treated if diagnosed earlier. It is the second most common gynecological malignancy worldwide and the leading cause of cancer associated mortality among women in Africa and Cameroon. This study sort to determine the current state of knowledge of cervical cancer and its risk factors in the Buea Health District of the South West Region of Cameroon. Methods This was a cross-sectional community based survey. We recruited 433 eligible women, in four (4) Health Areas (Molyko, Bolifamba, Muea and Buea Town) of the Buea Health District and used validated and pre-tested questionnaires to collect data. Collected data were keyed into Epi info version 7.2 statistical software and exported to SPSS Version 25 for analysis. Level of significance was set at P-value < 0.05. Results Fifty eight percent (58%) of the participants had good knowledge of cervical cancer. 58.99% (95%CI = 54.30-63.52) had good knowledge on the risk factors of cervical cancer. 40% knew at least one of the following risk factors; cigarette smoking, many sexual partners, family history of cervical cancer, being HIV/AIDS positive and giving birth 5 or more times. There was a significant association, OR = 7.5; 95%CI = 2.14-26.33; P = 0.001; X2 = 11.4 between having heard of cervical cancer and having “good” knowledge of cervical cancer among women in Buea. Conclusion Most of the women had heard of cervical cancer but the knowledge of the risk factors of cervical cancer among women aged 18-68 years in the Buea Health District is low. We found no association between awareness and knowledge of risk factors among the women.
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Affiliation(s)
- Ngwayu Claude Nkfusai
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.,Cameroon Baptist Convention Health Services (CBCHS), Yaoundé, Cameroon
| | - Samuel Nambile Cumber
- Institute of Medicine, Department of Public Health and Community Medicine (EPSO), University of Gothenburg, Box 414, SE - 405 30 Gothenburg, Sweden.,Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria Private Bag X323, Gezina, Pretoria, 0001, Pretoria, South Africa
| | - Judith K Anchang-Kimbi
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Kah Emmanuel Nji
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Joyce Shirinde
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria Private Bag X323, Gezina, Pretoria, 0001, Pretoria, South Africa
| | - Nota Damian Anong
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.,Department of Biological Sciences, Faculty of Science, University of Bamenda, Bamenda, Cameroon
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8
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Nkfusai NC, Cumber SN, Williams T, Anchang-Kimbi JK, Yankam BM, Anye CS, Tsoka-Gwegweni JM, George Enow EO, Anong DN. Cervical cancer in the Bamenda Regional Hospital, North West Region of Cameroon: a retrospective study. Pan Afr Med J 2019; 32:90. [PMID: 31223381 PMCID: PMC6560966 DOI: 10.11604/pamj.2019.32.90.18217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/07/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction Cervical cancer is ranked the 7th most common cancer in the world. Cancer of the cervix is the second most commonly diagnosed cancer after breast cancer and the third leading cause of cancer deaths among females in less developed countries. Incidence rates are highest in countries with low income. Nearly 90% of cervical cancer deaths occur in developing parts of the world. The study researchers therefore, carried out a retrospective study to determine the proportion of cervical cancer among other types of cancer in the cancer registry of the Bamenda Regional Hospital. Methods The objective of this study was to determine the proportion of cervical cancer among other types of cancers in the cancer registry of the Bamenda Regional Hospital, North West Region of Cameroon from past records. We reviewed all records from the registry of patients who attended the Bamenda Regional Hospital to screen and/or be operated upon for cervical cancer and other types of cancer. Socio-demographic and clinical characteristics of cases were captured using a data collection sheet: age, type of cancer, stage of cancer, type of surgery carried out and date of surgery. Data were entered and analysed in Statistical Package for Social Sciences (SPSS) version 25 software. Results 59 cancer cases were received in the center between 2012 and 2017. Of these, 31 (52%) had cervical cancer. Most patients who screened positive for cancer of the cervix were of the 50-54 age groups. Most of these patients (47.5%), were received at late stages (stages 3 and 4). Conclusion Over half (52%) of the patients receiving cancer care in this center have cervical cancer and generally turn up late for management.
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Affiliation(s)
- Ngwayu Claude Nkfusai
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.,Cameroon Baptist Convention Health Services (CBCHS), Yaoundé, Cameroon
| | - Samuel Nambile Cumber
- Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,Section for Epidemiology and Social Medicine, Department of Public Health, Institute of Medicine (EPSO), The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,School of Health Systems and Public Health Faculty of Health Sciences, University of Pretoria Private Bag X323, Gezina, Pretoria, 0001, Pretoria, South Africa
| | - Takang Williams
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Judith K Anchang-Kimbi
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Brenda Mbouamba Yankam
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.,Department of Statistics, Faculty of Physical Science, University of Nigeria, Nsukka, Nigeria
| | - Cho Sabastine Anye
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Joyce Mahlako Tsoka-Gwegweni
- Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal Durban, South Africa
| | | | - Damian Nota Anong
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.,Department of Biological Sciences, Faculty of Science, University of Bamenda, Bamenda, Cameroon
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Hillemanns P, Friese K, Dannecker C, Klug S, Seifert U, Iftner T, Hädicke J, Löning T, Horn L, Schmidt D, Ikenberg H, Steiner M, Freitag U, Siebert U, Sroczynski G, Sauerbrei W, Beckmann MW, Gebhardt M, Friedrich M, Münstedt K, Schneider A, Kaufmann A, Petry KU, Schäfer APA, Pawlita M, Weis J, Mehnert A, Fehr M, Grimm C, Reich O, Arbyn M, Kleijnen J, Wesselmann S, Nothacker M, Follmann M, Langer T, Jentschke M. Prevention of Cervical Cancer: Guideline of the DGGG and the DKG (S3 Level, AWMF Register Number 015/027OL, December 2017) - Part 1 with Introduction, Screening and the Pathology of Cervical Dysplasia. Geburtshilfe Frauenheilkd 2019; 79:148-159. [PMID: 30792545 PMCID: PMC6379164 DOI: 10.1055/a-0818-5440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/03/2018] [Accepted: 12/08/2018] [Indexed: 12/16/2022] Open
Abstract
Aims Annual opportunistic screening for cervical carcinoma has been carried out in Germany since 1971. The creation of this S3 guideline meets an important need, outlined in the National Cancer Plan, with regard to screening for cervical cancer, as the guideline aims to provide important information and support for planned organized screening for cervical cancer in Germany. Methods With the financial support of German Cancer Aid, 21 professional societies developed evidence-based statements and recommendations (classified using the GRADE system) for the screening, management and treatment of precancerous conditions of the cervix. Two independent scientific institutes compiled systematic reviews for this guideline. Recommendations The first part of this short summary presents the pathological basis and considers various questions related to screening for cervical cancer. As also reported in earlier reviews, the meta-analysis by Kleijnen Systematic Reviews showed that HPV-based screening offers better protection against invasive cervical cancer compared to cytology-based screening. The authors of this guideline therefore recommend - in accordance with the guideline of the Joint National Committee of Germany (Gemeinsamer Bundesauschuss, G-BA) - that women aged 35 and above should be examined at regular intervals (at least every 3 years) and undergo HPV-based screening. Co-testing can also be carried out. Women between the ages of 20 and 35 should have cytological screening every 2 years.
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Affiliation(s)
- Peter Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, München, Germany
| | - Stefanie Klug
- Lehrstuhl für Epidemiologie, Technische Universität München, München, Germany
| | - Ulrike Seifert
- Tumorepidemiologie, Universitäts KrebsCentrum (UCC), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Thomas Iftner
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Juliane Hädicke
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Thomas Löning
- Institut für Pathologie, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Lars Horn
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Dietmar Schmidt
- Institut für Pathologie, Referenzzentrum für Gynäkopathologie, Mannheim, Germany
| | - Hans Ikenberg
- CytoMol - MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - Manfred Steiner
- Facharzt für Frauenheilkunde und Geburtshilfe, Ihringen, Germany
| | - Ulrich Freitag
- Facharzt für Frauenheilkunde und Geburtshilfe, Wismar, Germany
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria.,Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
| | - Willi Sauerbrei
- Institut für Med. Biometrie und Statistik (IMBI), Universitätsklinikum Freiburg, Freiburg, Germany
| | | | | | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Karsten Münstedt
- Frauenklinik, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Achim Schneider
- Medizinisches Versorgungszentrum im Fürstenberg-Karree, Berlin, Germany
| | - Andreas Kaufmann
- Klinik für Gynäkologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Joachim Weis
- Klinik für Tumorbiologie, Klinik für Onkologische Rehabilitation - UKF Reha gGmbH, Freiburg, Germany
| | - Anja Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Mathias Fehr
- Gynäkologie & Geburtshilfe in Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | | | - Olaf Reich
- Privatklinik Graz Ragnitz, Graz, Austria
| | - Marc Arbyn
- Cancer Center, Sciensano, Brüssel, Belgium
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | | | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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Sato M, Horie K, Hara A, Miyamoto Y, Kurihara K, Tomio K, Yokota H. Application of deep learning to the classification of images from colposcopy. Oncol Lett 2018; 15:3518-3523. [PMID: 29456725 PMCID: PMC5795879 DOI: 10.3892/ol.2018.7762] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 11/20/2017] [Indexed: 02/05/2023] Open
Abstract
The objective of the present study was to investigate whether deep learning could be applied successfully to the classification of images from colposcopy. For this purpose, a total of 158 patients who underwent conization were enrolled, and medical records and data from the gynecological oncology database were retrospectively reviewed. Deep learning was performed with the Keras neural network and TensorFlow libraries. Using preoperative images from colposcopy as the input data and deep learning technology, the patients were classified into three groups [severe dysplasia, carcinoma in situ (CIS) and invasive cancer (IC)]. A total of 485 images were obtained for the analysis, of which 142 images were of severe dysplasia (2.9 images/patient), 257 were of CIS (3.3 images/patient), and 86 were of IC (4.1 images/patient). Of these, 233 images were captured with a green filter, and the remaining 252 were captured without a green filter. Following the application of L2 regularization, L1 regularization, dropout and data augmentation, the accuracy of the validation dataset was ~50%. Although the present study is preliminary, the results indicated that deep learning may be applied to classify colposcopy images.
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Affiliation(s)
- Masakazu Sato
- Department of Gynecology, Saitama Cancer Centre, Ina, Saitama 362-0806, Japan
| | - Koji Horie
- Department of Gynecology, Saitama Cancer Centre, Ina, Saitama 362-0806, Japan
| | - Aki Hara
- Department of Gynecology, Saitama Cancer Centre, Ina, Saitama 362-0806, Japan
| | - Yuichiro Miyamoto
- Department of Gynecology, Saitama Cancer Centre, Ina, Saitama 362-0806, Japan
| | - Kazuko Kurihara
- Department of Gynecology, Saitama Cancer Centre, Ina, Saitama 362-0806, Japan
| | - Kensuke Tomio
- Department of Gynecology, Saitama Cancer Centre, Ina, Saitama 362-0806, Japan
| | - Harushige Yokota
- Department of Gynecology, Saitama Cancer Centre, Ina, Saitama 362-0806, Japan
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Lee JH, Kim H, Choi H, Jeong H, Ko Y, Shim SH, Lee E, Chae SH. Contributions and Limitations of National Cervical Cancer Screening Program in Korea: A Retrospective Observational Study. Asian Nurs Res (Korean Soc Nurs Sci) 2018; 12:9-16. [PMID: 29463482 DOI: 10.1016/j.anr.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the contributions and limitations of the cervical cancer screening test with accuracy in Korea. METHODS This was a retrospective observational study. The study population consisted of all participants who underwent cervical cancer screening test from 2009 to 2014. The data were obtained from National Health Information Database (NHID) which represents medical use records of most Koreans. As the indices for contributions and limitations of the screening test, crude detection rate, incidence rate of interval cancer, sensitivity, specificity, and positive predictive value were used. RESULTS The crude detection rate of screening test per 100,000 participants increased from 100.7 in 2009 to 102.1 in 2014. The incidence rate of interval cancer per 100,000 negatives decreased from 13.0 in 2009 to 10.2 in 2014. The sensitivities of screening test were 88.7% in 2009 and 91.2% in 2014, and the specificities were 98.5% in 2009 and 97.7% in 2014. The positive predictive value of screening decreased from 6.2% in 2009 to 4.3% in 2014. CONCLUSION The Korean national cervical cancer screening program has improved in accuracy and has contributed to detection of early stage of cervical cancer over the years. Along with efforts to promote participation in cancer screening programs, quality control over the screening program should be enhanced.
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Affiliation(s)
- Jung Hyun Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Republic of Korea.
| | - Heejung Choi
- Department of Nursing, College of Nursing, Konkuk University, Seoul, Republic of Korea
| | - Hyoseon Jeong
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Young Ko
- Department of Nursing, College of Nursing, Gachon University, Incheon, Republic of Korea
| | - Seung-Hyuk Shim
- Department of Obstetrics and Gynecology, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Eunjoo Lee
- Bigdata Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Su Hyun Chae
- Department of Obstetrics and Gynecology, School of Medicine, Konkuk University, Seoul, Republic of Korea
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Koliopoulos G, Nyaga VN, Santesso N, Bryant A, Martin‐Hirsch PPL, Mustafa RA, Schünemann H, Paraskevaidis E, Arbyn M. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Rev 2017; 8:CD008587. [PMID: 28796882 PMCID: PMC6483676 DOI: 10.1002/14651858.cd008587.pub2] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cervical cancer screening has traditionally been based on cervical cytology. Given the aetiological relationship between human papillomavirus (HPV) infection and cervical carcinogenesis, HPV testing has been proposed as an alternative screening test. OBJECTIVES To determine the diagnostic accuracy of HPV testing for detecting histologically confirmed cervical intraepithelial neoplasias (CIN) of grade 2 or worse (CIN 2+), including adenocarcinoma in situ, in women participating in primary cervical cancer screening; and how it compares to the accuracy of cytological testing (liquid-based and conventional) at various thresholds. SEARCH METHODS We performed a systematic literature search of articles in MEDLINE and Embase (1992 to November 2015) containing quantitative data and handsearched the reference lists of retrieved articles. SELECTION CRITERIA We included comparative test accuracy studies if all women received both HPV testing and cervical cytology followed by verification of the disease status with the reference standard, if positive for at least one screening test. The studies had to include women participating in a cervical cancer screening programme who were not being followed up for previous cytological abnormalities. DATA COLLECTION AND ANALYSIS We completed a 2 x 2 table with the number of true positives (TP), false positives (FP), true negatives (TN), and false negatives for each screening test (HPV test and cytology) used in each study. We calculated the absolute and relative sensitivities and the specificities of the tests for the detection of CIN 2+ and CIN 3+ at various thresholds and computed sensitivity (TP/(TP + TN) and specificity (TN/ (TN + FP) for each test separately. Relative sensitivity and specificity of one test compared to another test were defined as sensitivity of test-1 over sensitivity of test-2 and specificity of test-1 over specificity of test-2, respectively. To assess bias in the studies, we used the Quality Assessment of Diagnostic test Accuracy Studies (QUADAS) tool. We used a bivariate random-effects model for computing pooled accuracy estimates. This model takes into account the within- and between-study variability and the intrinsic correlation between sensitivity and specificity. MAIN RESULTS We included a total of 40 studies in the review, with more than 140,000 women aged between 20 and 70 years old. Many studies were at low risk of bias. There were a sufficient number of included studies with adequate methodology to perform the following test comparisons: hybrid capture 2 (HC2) (1 pg/mL threshold) versus conventional cytology (CC) (atypical squamous cells of undetermined significance (ASCUS)+ and low-grade squamous intraepithelial lesions (LSIL)+ thresholds) or liquid-based cytology (LBC) (ASCUS+ and LSIL+ thresholds), other high-risk HPV tests versus conventional cytology (ASCUS+ and LSIL+ thresholds) or LBC (ASCUS+ and LSIL+ thresholds). For CIN 2+, pooled sensitivity estimates for HC2, CC and LBC (ASCUS+) were 89.9%, 62.5% and 72.9%, respectively, and pooled specificity estimates were 89.9%, 96.6%, and 90.3%, respectively. The results did not differ by age of women (less than or greater than 30 years old), or in studies with verification bias. Accuracy of HC2 was, however, greater in European countries compared to other countries. The results for the sensitivity of the tests were heterogeneous ranging from 52% to 94% for LBC, and 61% to 100% for HC2. Overall, the quality of the evidence for the sensitivity of the tests was moderate, and high for the specificity.The relative sensitivity of HC2 versus CC for CIN 2+ was 1.52 (95% CI: 1.24 to 1.86) and the relative specificity 0.94 (95% CI: 0.92 to 0.96), and versus LBC for CIN 2+ was 1.18 (95% CI: 1.10 to 1.26) and the relative specificity 0.96 (95% CI: 0.95 to 0.97). The relative sensitivity of HC2 versus CC for CIN 3+ was 1.46 (95% CI: 1.12 to 1.91) and the relative specificity 0.95 (95% CI: 0.93 to 0.97). The relative sensitivity of HC2 versus LBC for CIN 3+ was 1.17 (95% CI: 1.07 to 1.28) and the relative specificity 0.96 (95% CI: 0.95 to 0.97). AUTHORS' CONCLUSIONS Whilst HPV tests are less likely to miss cases of CIN 2+ and CIN 3+, these tests do lead to more unnecessary referrals. However, a negative HPV test is more reassuring than a negative cytological test, as the cytological test has a greater chance of being falsely negative, which could lead to delays in receiving the appropriate treatment. Evidence from prospective longitudinal studies is needed to establish the relative clinical implications of these tests.
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Affiliation(s)
- George Koliopoulos
- Elena Venizelou Maternity HospitalDepartment of Obstetrics and Gynaecology1 Elena Venizelou SquareAthensGreece11521
| | - Victoria N Nyaga
- Scientific Institute of Public HealthUnit of Cancer EpidemiologyJuliette Wytsmanstraat 14BrusselsBelgium1050
| | - Nancy Santesso
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Pierre PL Martin‐Hirsch
- Royal Preston Hospital, Lancashire Teaching Hospital NHS TrustGynaecological Oncology UnitSharoe Green LaneFullwoodPrestonLancashireUKPR2 9HT
| | - Reem A Mustafa
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Holger Schünemann
- McMaster UniversityDepartments of Health Research Methods, Evidence, and Impact and of Medicine1280 Main Street WestHamiltonONCanadaL8N 4K1
| | | | - Marc Arbyn
- SciensanoUnit of Cancer Epidemiology, Belgian Cancer CentreJuliette Wytsmanstreet 14BrusselsBelgiumB‐1050
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Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion triage in Korean women: Revisiting the 2012 American Society of Colposcopy and Cervical Pathology screening guidelines. Obstet Gynecol Sci 2017; 60:357-361. [PMID: 28791267 PMCID: PMC5547083 DOI: 10.5468/ogs.2017.60.4.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/27/2017] [Accepted: 03/24/2017] [Indexed: 12/21/2022] Open
Abstract
Objective To determine whether triage for atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) from the updated American Society for Colposcopy and Cervical Pathology cervical cancer screening guidelines is applicable in Korean women. Methods We investigated women with ASC-US or LSIL including referred from local hospitals visited for cervical cancer screening at Korea University Guro Hospital from February 2004 to December 2014. Detailed information on the results of Papanicolaou (Pap) smears, human papillomavirus (HPV) DNA tests, and cervical biopsies were collected through chart review. Cervical biopsy results were compared in eligible women according to individual Pap smear findings and HPV DNA status. Results Of 216,723 possible cases, 3,196 were included. There were 212 (6.6%) women with ASC-US and 500 (15.6%) with LSIL. The risk of ≥cervical intraepithelial neoplasia (CIN) 2 was significantly higher in women who were ASC-US/HPV+ than ASC-US/HPV- and LSIL/HPV+ than LSIL/HPV- (93.3% vs. 6.7% and 96.7% vs. 3.3%, P<0.001 and P<0.001, respectively). The risk of ≥CIN 3 was also significantly higher in women who were ASC-US/HPV+ than ASC-US/HPV- and LSIL/HPV+ than LSIL/HPV- (97.0% vs. 3.0% and 93.0% vs. 7.0%, P<0.001 and P<0.001, respectively). Age-stratified analysis revealed that more CIN 2 or CIN 3 was diagnosed in women aged 30 to 70 with ASC-US or LSIL when HPV DNA was present. Conclusion Observation with Pap and HPV DNA tests rather than immediate colposcopy is a reasonable strategy for ASC-US or LSIL when the HPV DNA test is negative, especially in women aged 30 to 70. Reflection of these results should be considered in future Korean screening guidelines.
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Selva Ganesh S, Sabarinath B, Sivapathasundharam B. Comparison of conventional smear cytology and manual liquid based cytology based on smears from normal oral exfoliated cells. J Histotechnol 2017. [DOI: 10.1080/01478885.2017.1355430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S. Selva Ganesh
- Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College and Hospital, Chennai, India
| | - B. Sabarinath
- Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College and Hospital, Chennai, India
| | - B. Sivapathasundharam
- Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College and Hospital, Chennai, India
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Puerto de Amaya MB. Anomalías epiteliales glandulares y la importancia de los diagnósticos diferenciales. Estudio de caso. REPERTORIO DE MEDICINA Y CIRUGÍA 2017. [DOI: 10.1016/j.reper.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rozemeijer K, Naber SK, Penning C, Overbeek LIH, Looman CWN, de Kok IMCM, Matthijsse SM, Rebolj M, van Kemenade FJ, van Ballegooijen M. Cervical cancer incidence after normal cytological sample in routine screening using SurePath, ThinPrep, and conventional cytology: population based study. BMJ 2017; 356:j504. [PMID: 28196844 PMCID: PMC5421440 DOI: 10.1136/bmj.j504] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective To compare the cumulative incidence of cervical cancer diagnosed within 72 months after a normal screening sample between conventional cytology and liquid based cytology tests SurePath and ThinPrep.Design Retrospective population based cohort study.Setting Nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA), January 2000 to March 2013.Population Women with 5 924 474 normal screening samples (23 833 123 person years).Exposure Use of SurePath or ThinPrep versus conventional cytology as screening test.Main outcome measure 72 month cumulative incidence of invasive cervical cancer after a normal screening sample for each screening test. Cox regression analyses assessed the hazard ratios, adjusted for calendar time, age, screening history, and socioeconomic status and including laboratories as random effects.Results The 72 month cumulative cancer incidence was 58.5 (95% confidence interval 54.6 to 62.7) per 100 000 normal conventional cytology samples, compared with 66.8 (56.7 to 78.7) for ThinPrep and 44.6 (37.8 to 52.6) for SurePath. Compared with conventional cytology, the hazard of invasive cancer was 19% lower (hazard ratio 0.81, 95% confidence interval 0.66 to 0.99) for SurePath, mainly caused by a 27% lower hazard (0.73, 0.57 to 0.93) of a clinically detected cancer. For ThinPrep, the hazard was on average 15% higher (hazard ratio 1.15, 0.95 to 1.38), mainly caused by a 56% higher hazard of a screen detected cancer (1.56, 1.17 to 2.08).Conclusions These findings should provoke reconsideration of the assumed similarity in sensitivity to detect progressive cervical intraepithelial neoplasia between different types of liquid based cytology and conventional cytology.
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Affiliation(s)
- Kirsten Rozemeijer
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Steffie K Naber
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Corine Penning
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Lucy I H Overbeek
- PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, Houten, Netherlands
| | - Caspar W N Looman
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Suzette M Matthijsse
- Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Matejka Rebolj
- Clinical Research Centre and Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
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Current Technologies and Recent Developments for Screening of HPV-Associated Cervical and Oropharyngeal Cancers. Cancers (Basel) 2016; 8:cancers8090085. [PMID: 27618102 PMCID: PMC5040987 DOI: 10.3390/cancers8090085] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 12/27/2022] Open
Abstract
Mucosal infection by the human papillomavirus (HPV) is responsible for a growing number of malignancies, predominantly represented by cervical cancer and oropharyngeal squamous cell carcinoma. Because of the prevalence of the virus, persistence of infection, and long latency period, novel and low-cost methods are needed for effective population level screening and monitoring. We review established methods for screening of cervical and oral cancer as well as commercially-available techniques for detection of HPV DNA. We then describe the ongoing development of microfluidic nucleic acid-based biosensors to evaluate circulating host microRNAs that are produced in response to an oncogenic HPV infection. The goal is to develop an ideal screening platform that is low-cost, portable, and easy to use, with appropriate signal stability, sensitivity and specificity. Advances in technologies for sample lysis, pre-treatment and concentration, and multiplexed nucleic acid detection are provided. Continued development of these devices provides opportunities for cancer screening in low resource settings, for point-of-care diagnostics and self-screening, and for monitoring response to vaccination or surgical treatment.
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Bansal B, Gupta P, Gupta N, Rajwanshi A, Suri V. Detecting uterine glandular lesions: Role of cervical cytology. Cytojournal 2016; 13:3. [PMID: 27014363 PMCID: PMC4785776 DOI: 10.4103/1742-6413.177156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/23/2015] [Indexed: 11/21/2022] Open
Abstract
Background: The sensitivity of cervical cytology for detection of glandular lesions is reported to be low. We conducted this study to assess the diagnostic accuracy of cervical Papanicolaou (Pap) smears for uterine glandular lesions and to compare the diagnostic utility of conventional and liquid-based cytology (LBC) smears for glandular lesions. Materials and Methods: Archived histopathology records of all cases reported as endocervical and endometrial adenocarcinoma in the study period were identified and the available corresponding Pap smears (in preceding 1 year) were retrieved. In addition, the Pap smears reported as glandular cell abnormalities (GCA) during the same study period were retrieved. The overall prevalence of GCA, sensitivity, and specificity of Pap smears for the detection of GCA was calculated. The diagnostic accuracy of conventional and LBC smears for the diagnosis of GCA was also compared. Results: The prevalence of GCA in our study was 0.32%. The overall specificity of Pap smears for the diagnosis of GCA was 60.8%, this was not significantly different between conventional and LBC smears (P = 0.4). The overall sensitivity of Pap smears for the detection of GCA was 41.8%; LBC smears had significantly better sensitivity as compared to conventional smears for the detection of endometrial as compared to endocervical adenocarcinoma (P < 0.05). Conclusions: The prevalence of GCA in Pap smears is low. The specificity of Pap smears, for diagnosis of GCA, was found to be moderate. However, the overall sensitivity of Pap smears for the detection of GCA was low, though better for LBC as compared to conventional smears.
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Affiliation(s)
- Baneet Bansal
- Address: Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Address: Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Address: Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Address: Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sander B, Wong WWL, Yeung MW, Ormanidhi O, Atkin K, Murphy J, Krahn M, Deeks SL. The cost-utility of integrated cervical cancer prevention strategies in the Ontario setting - Can we do better? Vaccine 2016; 34:1936-44. [PMID: 26892739 DOI: 10.1016/j.vaccine.2016.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/15/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION A universal, publicly funded, school-based human papillomavirus (HPV) vaccination program in grade eight girls was initiated in Ontario in 2007. We present a cost-utility analysis of integrated cervical cancer prevention programs from the healthcare payer perspective. METHODS Our analysis was based on linked HPV transmission and disease history models. We obtained data from the literature, provincial surveys and Ontario population-based linked health administrative datasets. We modeled combinations of vaccination and screening strategies. We considered vaccination based on the Ontario experience, as well as conservative and optimistic scenarios, varying coverage, vaccine effectiveness and duration of protection. We considered 900 screening scenarios (screening start age: 21-70 years, screening interval: 3-20 years; 1-year time steps). The current schedule screens every 3 years starting at age 21 years. We examined (1) first vaccinated cohort (low herd-immunity), and (2) steady state, i.e. all cohorts were vaccinated (high herd-immunity). RESULTS Adding vaccination to the current screening schedule was cost-effective (<C$10,000/quality-adjusted life year (QALY)) across all scenarios. Delaying screening start and/or extending screening intervals increased both expected QALYs and cost, and increased overall NHB for screening schedules with a start age of 25-35 years and 3-10-year intervals for most scenarios. CONCLUSION Delaying screening start age and/or extending screening intervals in vaccinated cohorts is likely to be cost-effective. Consideration should be given to both the short- and long-term implications of health policy decisions, particularly for infectious disease interventions that require long time intervals to reach steady state.
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Affiliation(s)
- Beate Sander
- Public Health Ontario, Canada; University of Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Canada.
| | - William W L Wong
- University of Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Canada
| | | | - Orges Ormanidhi
- Toronto Health Economics and Technology Assessment Collaborative, Canada
| | | | - Joan Murphy
- University of Toronto, Canada; Cancer Care Ontario, Canada; University Health Network, Toronto, Canada
| | - Murray Krahn
- University of Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Canada; University Health Network, Toronto, Canada
| | - Shelley L Deeks
- Public Health Ontario, Canada; University of Toronto, Canada
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The advantages of incorporating liquid-based cytology (TACAS™) in mass screening for cervical cancer. Hum Cell 2016; 29:83-90. [PMID: 26739336 DOI: 10.1007/s13577-015-0130-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
We incorporated liquid-based cytology (LBC) in population-based screening for cervical cancer. The usefulness of using LBC in mass screening for cervical cancer was examined. From 2009 to 2014, 157,061 individuals underwent mass screening for cervical cancer in Aomori Prefecture. From 2009 to 2011, cells were collected from 82,218 individuals and the specimens were conventionally prepared (CP). From 2012 to 2014, cells were collected from 74,843 individuals and the specimens were prepared using LBC (TACAS™). Cytology results for the 2 sets of specimens were compared and differences in cytologic features were examined. ASC-US and more severe lesions were detected at a rate of 1.13 % by CP and 1.44 % by LBC, so LBC had a 1.3-fold higher rate of detection. LBC had a 1.6-fold higher rate of LSIL detection and a 1.2-fold higher rate of HSIL detection. CP detected cancer in 20 cases at a rate of 0.024 % while LBC detected cancer in 18 cases at a rate of 0.024 %. Cytodiagnosis of the 18 cases of SCC that LBC identified revealed that 7 were SCC, 8 were HSIL, and 3 were ASC-H. Atypical cells tended to be smaller with TACAS™. LBC reduced the time needed for microscopic examination of a single specimen by 42 % in comparison to CP. LBC using TACAS™ allowed the detection of slight lesions and slight changes in cells. LBC can lessen the burden on medical personnel and may lead to improved accuracy.
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21
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Rozemeijer K, Penning C, Siebers AG, Naber SK, Matthijsse SM, van Ballegooijen M, van Kemenade FJ, de Kok IMCM. Comparing SurePath, ThinPrep, and conventional cytology as primary test method: SurePath is associated with increased CIN II+ detection rates. Cancer Causes Control 2015; 27:15-25. [PMID: 26458884 PMCID: PMC4703623 DOI: 10.1007/s10552-015-0678-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/23/2015] [Indexed: 12/20/2022]
Abstract
Purpose Within the last decade, SurePath and ThinPrep [both liquid-based cytology (LBC) tests] have replaced conventional cytology (CC) as primary test method in cervical cancer screening programs of multiple countries. The aim of our study was to examine the effect in the Dutch screening program. Methods All primary smears taken within this program from 2000 to 2011 were analyzed using the nationwide registry of histo- and cytopathology (PALGA) with a follow-up until March 2013. The percentage of smears classified as borderline/mildly dyskaryotic (BMD) and >BMD as well as CIN and cervical cancer detection rates were compared between SurePath and ThinPrep versus CC by logistic regression analyses (adjusted for age, screen region, socioeconomic status, and calendar time). Results We included 3,118,685 CC, 1,313,731 SurePath, and 1,584,587 ThinPrep smears. Using SurePath resulted in an increased rate of primary smears classified as >BMD [odds ratio (OR) = 1.12 (95% confidence interval (CI) 1.09–1.16)]. CIN I and II+ detection rates increased by 14 % [OR = 1.14 (95% CI 1.08–1.20)] and 8 % [OR = 1.08 (95% CI 1.05–1.12)]. Cervical cancer detection rates were unaffected. Implementing ThinPrep did not result in major alterations of the cytological classification of smears, and it did not affect CIN detection rates.
While not significant, cervical cancer detection rates were lower [OR = 0.87 (95% CI 0.75–1.01)]. Conclusions The impact of replacing CC by LBC as primary test method depends on the type of LBC test used.
Only the use of SurePath was associated with increased CIN II+ detection, although it simultaneously increased the detection of CIN I.
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Affiliation(s)
- Kirsten Rozemeijer
- Department of Public Health, Erasmus MC, University Medical Center, Room Na-2223, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Corine Penning
- Department of Public Health, Erasmus MC, University Medical Center, Room Na-2223, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Albert G Siebers
- Department of Pathology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.,PALGA, The Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands, Randhoeve 231A, 3995, GA, Houten, The Netherlands
| | - Steffie K Naber
- Department of Public Health, Erasmus MC, University Medical Center, Room Na-2223, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Suzette M Matthijsse
- Department of Public Health, Erasmus MC, University Medical Center, Room Na-2223, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Marjolein van Ballegooijen
- Department of Public Health, Erasmus MC, University Medical Center, Room Na-2223, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center, Room Na-2223, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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22
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Cervical histology after routine ThinPrep or SurePath liquid-based cytology and computer-assisted reading in Denmark. Br J Cancer 2015; 113:1259-74. [PMID: 26448176 PMCID: PMC4815798 DOI: 10.1038/bjc.2015.339] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/10/2015] [Accepted: 08/24/2015] [Indexed: 12/14/2022] Open
Abstract
Background: We compared the sensitivity and specificity of liquid-based cytology (LBC) and computer-assisted reading for SurePath/FocalPoint and ThinPrep with those of manually read conventional cytology in routine cervical screening in four Danish laboratories. Methods: Using data from five nationwide registers, technological phases were identified by slide preparation, reading technique, and triage of borderline cytology. Trends in the detection of cervical intraepithelial neoplasia (CIN) were an indicator of the technology's relative sensitivity, and trends in false-positive tests an indicator of relative specificity. Results: At 23–29 years, SurePath/FocalPoint statistically significantly increased the detection of ⩾CIN3 by 85% compared with manually read conventional cytology. The 11% increase with ThinPrep was not significant. At 30–44 years, the increase with SurePath/FocalPoint was 58% the 16% increase with ThinPrep was not significant. At 45–59 years, both technologies led to nonsignificant decreases in the detection. SurePath/FocalPoint doubled the frequency of false-positive tests at any age. With ThinPrep, these proportions remained the same at 23–29 years, but decreased by two-thirds at 45–59 years. In a fourth laboratory with continuous use of manually read conventional cytology, no such trends were seen. Conclusions: The sensitivity and specificity of modern LBC and computer-assisted reading technologies may be brand- and age-dependent.
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Costa MOLP, Heráclio SA, Coelho AVC, Acioly VL, Souza PRE, Correia MTS. Comparison of conventional Papanicolaou cytology samples with liquid-based cervical cytology samples from women in Pernambuco, Brazil. ACTA ACUST UNITED AC 2015; 48:831-8. [PMID: 26247400 PMCID: PMC4568811 DOI: 10.1590/1414-431x20154252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 03/09/2015] [Indexed: 11/22/2022]
Abstract
In the present study, we compared the performance of a ThinPrep cytological method
with the conventional Papanicolaou test for diagnosis of cytopathological changes,
with regard to unsatisfactory results achieved at the Central Public Health
Laboratory of the State of Pernambuco. A population-based, cross-sectional study was
performed with women aged 18 to 65 years, who spontaneously sought gynecological
services in Public Health Units in the State of Pernambuco, Northeast Brazil, between
April and November 2011. All patients in the study were given a standardized
questionnaire on sociodemographics, sexual characteristics, reproductive practices,
and habits. A total of 525 patients were assessed by the two methods (11.05% were
under the age of 25 years, 30.86% were single, 4.4% had had more than 5 sexual
partners, 44% were not using contraception, 38.85% were users of alcohol, 24.38% were
smokers, 3.24% had consumed drugs previously, 42.01% had gynecological complaints,
and 12.19% had an early history of sexually transmitted diseases). The two methods
showed poor correlation (k=0.19; 95%CI=0.11–0.26; P<0.001). The
ThinPrep method reduced the rate of unsatisfactory results from 4.38% to 1.71%
(χ2=5.28; P=0.02), and the number of cytopathological changes diagnosed
increased from 2.47% to 3.04%. This study confirmed that adopting the ThinPrep method
for diagnosis of cervical cytological samples was an improvement over the
conventional method. Furthermore, this method may reduce possible losses from
cytological resampling and reduce obstacles to patient follow-up, improving the
quality of the public health system in the State of Pernambuco, Northeast Brazil.
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Affiliation(s)
- M O L P Costa
- Laboratório Central de Saúde Pública do Estado de Pernambuco, Recife, PE, BR
| | - S A Heráclio
- Laboratório Central de Saúde Pública do Estado de Pernambuco, Recife, PE, BR
| | - A V C Coelho
- Departamento de Genética, Universidade Federal de Pernambuco, Recife, PE, BR
| | - V L Acioly
- Laboratório Central de Saúde Pública do Estado de Pernambuco, Recife, PE, BR
| | - P R E Souza
- Departamento de Biologia, Universidade Federal Rural de Pernambuco, Recife, PE, BR
| | - M T S Correia
- Departamento de Bioquímica, Universidade Federal de Pernambuco, Recife, PE, BR
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24
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Min KJ, Lee YJ, Suh M, Yoo CW, Lim MC, Choi J, Ki M, Kim YM, Kim JW, Kim JH, Park EW, Lee HY, Lim SC, Cho CH, Hong SR, Dang JY, Kim SY, Kim Y, Lee WC, Lee JK. The Korean guideline for cervical cancer screening. J Gynecol Oncol 2015. [PMID: 26197860 DOI: 10.3802/jgo.2015.26.3.232.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D).
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Affiliation(s)
- Kyung Jin Min
- Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, Korea
| | - Yoon Jae Lee
- Department of Korean Gynecology, Jaseng Hospital of Korean Medicine, Seoul, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Chong Woo Yoo
- Center for Uterine Cancer and Department of Pathology, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Hospital, Gynecologic Cancer Branch, Research Institute, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jaekyung Choi
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Moran Ki
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yong Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jea Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eal Whan Park
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hoo Yeon Lee
- Department of Social Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Sung Chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
| | - Chi Heum Cho
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Ji Yeon Dang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Soo Young Kim
- Department of Family Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Won Chul Lee
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, Korea.
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25
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Min KJ, Lee YJ, Suh M, Yoo CW, Lim MC, Choi J, Ki M, Kim YM, Kim JW, Kim JH, Park EW, Lee HY, Lim SC, Cho CH, Hong SR, Dang JY, Kim SY, Kim Y, Lee WC, Lee JK. The Korean guideline for cervical cancer screening. J Gynecol Oncol 2015; 26. [PMID: 26197860 PMCID: PMC4510341 DOI: 10.3802/jgo.2015.26.3.232] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D).
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Affiliation(s)
- Kyung Jin Min
- Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, Korea
| | - Yoon Jae Lee
- Department of Korean Gynecology, Jaseng Hospital of Korean Medicine, Seoul, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Chong Woo Yoo
- Center for Uterine Cancer and Department of Pathology, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Hospital, Gynecologic Cancer Branch, Research Institute, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jaekyung Choi
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Moran Ki
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yong Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jea Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eal Whan Park
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hoo Yeon Lee
- Department of Social Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Sung Chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
| | - Chi Heum Cho
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Ji Yeon Dang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Soo Young Kim
- Department of Family Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Won Chul Lee
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, Korea.
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26
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Byrne HJ, Baranska M, Puppels GJ, Stone N, Wood B, Gough KM, Lasch P, Heraud P, Sulé-Suso J, Sockalingum GD. Spectropathology for the next generation: Quo vadis? Analyst 2015; 140:2066-73. [DOI: 10.1039/c4an02036g] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vibrational spectroscopy for biomedical applications has shown great promise although its translation into clinical practice has, as yet, been relatively slow. This Editorial assesses the challenges facing the field and the potential way forward.
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Affiliation(s)
- Hugh J. Byrne
- FOCAS Research Institute
- Dublin Institute of Technology
- Dublin 8
- Ireland
| | | | - Gerwin J. Puppels
- RiverD International B.V
- 3029 AK Rotterdam
- the Netherlands
- Erasmus-University Medical Center
- Center for Optical Diagnostics & Therapy
| | - Nick Stone
- Biomedical Spectroscopy Lab
- School of Physics
- College of Engineering
- Mathematics and Physical Sciences
- University of Exeter
| | - Bayden Wood
- Centre for Biospectroscopy and School of Chemistry
- Monash University
- Clayton
- Australia
| | | | - Peter Lasch
- Robert Koch-Institut
- Center for Biological Threats and Special Pathogens: Proteomics and Spectroscopy (ZBS6)
- 13353 Berlin
- Germany
| | - Phil Heraud
- Centre for Biospectroscopy and School of Chemistry
- Monash University
- Australia
| | - Josep Sulé-Suso
- Institute for Science & Technology in Medicine
- Keele University
- Stoke-on-Trent
- UK
| | - Ganesh D. Sockalingum
- Université de Reims Champagne-Ardenne
- MéDIAN-Biophotonique et Technologies pour la Santé
- UFR de Pharmacie
- 51096 Reims Cedex
- France
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27
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Min KJ, Lee YJ, Suh M, Yoo CW, Lim MC, Choi J, Ki M, Kim YM, Kim JW, Kim JH, Park EW, Lee HY, Lim SC, Cho CH, Hong SR, Dang JY, Kim SY, Kim Y, Lee WC, Lee JK. The Korean guideline for cervical cancer screening. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.5.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Kyung-Jin Min
- Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, Korea
| | - Yoon Jae Lee
- Department of Korean Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Chong Woo Yoo
- Center for Uterine Cancer/Department of Pathology, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Hospital, Gynecologic Cancer Branch, Research Institute, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jaekyung Choi
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Moran Ki
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Jea-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eal Whan Park
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hoo-Yeon Lee
- Department of Social Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Sung-Chul Lim
- Department of Pathology, Chosun Universtiy Medical School, Gwangju, Korea
| | - Chi-Heum Cho
- Department of Obstetrics and Gynecology, Keimyung Universtiy School of Medicine, Daegu, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Ji Yeon Dang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Soo Young Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Won-Chul Lee
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae-Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul, Korea
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28
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Tavares SBDN, de Souza NLA, Manrique EJC, Azara CZS, da Silveira EA, Amaral RG. Internal quality control for cervical cytopathology: comparison of potential false-negatives detected at rapid prescreening and at 100% rapid review. Acta Cytol 2014; 58:439-45. [PMID: 25376096 DOI: 10.1159/000368041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 09/01/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the performance of rapid prescreening (RPS) and 100% rapid review (RR-100%) as internal quality control (IQC) methods assessed by outcome at colposcopy, histopathology and repeat cytopathology for cases with false-negative results on cervical cytopathology at routine screening (RS). STUDY DESIGN Out of 12,208 cytology smears analyzed, 900 were abnormal. Of these, 656 were identified at RS, and 244 were false-negative, with 90.2% identified at RPS and 57.4% at RR-100%. Of the 900 abnormal cases, 436 were submitted for additional testing. RESULTS Of the 244 women with cytopathological abnormalities identified only by the IQC methods, 114 had supplementary examinations: 35 were submitted for colposcopy, 22 for biopsy and 99 for repeat cytopathology. The sensitivity of RPS for the detection of abnormalities identified on colposcopy, histopathology and repeat cytopathology was 87.5% (95% CI 67.6-97.3), 82.4% (95% CI 56.6-96.2) and 95.7% (95% CI 85.2-99.5), respectively. The sensitivity of RR-100% was 54.2% (95% CI 32.8-74.4), 52.9% (95% CI 27.8-77.0) and 47.8% (95% CI 32.9-63.1), respectively. RPS was more sensitive than RR-100% when compared to the findings on colposcopy (p = 0.011) and repeat cytopathology (p = 0.000). When compared to colposcopy, histopathology and repeat cytopathology, the sensitivity of RS was 83.2% (95% CI 76.1-88.9), 85.7% (95% CI 78.1-91.5) and 73.3% (95% CI 66.0-79.7), respectively. CONCLUSION RPS performed better than RR-100% when compared to the results of colposcopy and repeat cytopathology.
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29
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Yin D, Jiang Y, Wang N, Ouyang L, Lu Y, Zhang Y, Wei H, Zhang S. The diagnostic value of serum hybrid capture 2 (CH2) HPV DNA in cervical cancer: a systematic review and meta-analysis. Tumour Biol 2014; 35:9247-53. [PMID: 24935474 DOI: 10.1007/s13277-014-2214-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 06/09/2014] [Indexed: 12/14/2022] Open
Abstract
The diagnostic accuracy of cervical cancer remains a clinical challenge, and a number of studies have used the serum hybrid capture 2 (HC2) human papillomavirus (HPV) DNA in the diagnosis of cervical cancer. The aim of the present meta-analysis was to determine the overall accuracy of HC2 HPV DNA in the diagnosis of cervical cancer. A systematic review of studies from PubMed, Embase, the Cochrane Library, Web of Science, Ovid, Chinese Biomedical Literature Database-disc, Chinese National Knowledge Infrastructure (CNKI), Technology of Chongqing (VIP), and Wan Fang database was conducted, and the data concerning the accuracy of HC2 HPV DNA in the diagnosis of cervical cancer were pooled. The methodological quality of each study was assessed by quality assessment for studies of diagnostic accuracy (QUADAS). Statistical analysis was performed by employing Meta-DiSc (version 1.4) and Stata (version 12.0) software. The overall test performance was summarized using receiver operating characteristic curves. Finally, 12 studies, including 12,492 subjects, met the inclusion criteria and then included in this present meta-analysis. The summary estimates for serum HC2 HPV DNA in the diagnosis of cervical cancer were as follows: sensitivity 0.83 (95 % confidence interval (CI) 0.81-0.85), specificity 0.71 (95 % CI 0.69-0.72), positive likelihood ratio 3.65 (95 % CI 1.77-7.54), negative likelihood ratio 0.32 (95 % CI 0.21-0.48), and diagnostic odds ratio 10.54 (95 % CI 4.95-22.46), and the area under the curve was 0.8922. Our findings suggest that HC2 HPV DNA may improve the accuracy of cervical cancer diagnosis, while the results of HC2 HPV DNA assays should be interpreted in parallel with conventional test results and other clinical findings.
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Affiliation(s)
- Duo Yin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
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30
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Kumar RV, Bhasker S. Optimizing cervical cancer care in resource-constrained developing countries by tailoring community prevention and clinical management protocol. J Cancer Policy 2014. [DOI: 10.1016/j.jcpo.2013.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Richardson LA, Tota J, Franco EL. Optimizing technology for cervical cancer screening in high-resource settings. ACTA ACUST UNITED AC 2014; 6:343-353. [PMID: 26617667 DOI: 10.1586/eog.11.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although historically successful in reducing the burden of cervical cancer, Papanicolaou (Pap) testing faces numerous limitations. A growing body of evidence suggests that modern screening practice will benefit from primary screening for high-risk human papillomavirus (HPV) infection, the causative agent of cervical cancer. Molecular tests detecting the presence of HPV nucleic acids consistently demonstrate high sensitivity relative to Pap testing, and provide reliable, dichotomous results. Pap cytology is ideally suited to triage HPV-positive cases owing to its high test specificity, and the accuracy of cytological readings will be maximized in high-prevalence conditions. This algorithm of primary HPV testing with Pap triage has been shown to maintain the high sensitivity of HPV testing without compromising Pap cytology's strong ability to rule out falsely positive diagnoses. Given the anticipated decline of high-risk HPV-16 and -18 infections in the emergent post-HPV vaccination era, highly sensitive primary HPV testing is especially warranted. Novel screening technologies that identify HPV viral gene expression continue to emerge and seek to complement current HPV testing by identifying those women who may be at risk of progressive disease. How to best incorporate these new technologies into clinical practice presents our next great challenge. Implementation of novel algorithms for cervical screening is not a trivial task. Avoidance of exceedingly complex screening algorithms is an important priority.
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Affiliation(s)
- Lyndsay A Richardson
- Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada
| | - Joseph Tota
- Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada
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32
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Chen YC, Huang RL, Huang YK, Liao YP, Su PH, Wang HC, Chang CC, Lin YW, Yu MH, Chu TY, Lai HC. Methylomics analysis identifies epigenetically silenced genes and implies an activation of β-catenin signaling in cervical cancer. Int J Cancer 2013; 135:117-27. [PMID: 24310984 DOI: 10.1002/ijc.28658] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/14/2013] [Accepted: 11/20/2013] [Indexed: 12/17/2022]
Abstract
Using DNA methylation biomarkers in cancer detection is a potential direction in clinical testing. Some methylated genes have been proposed for cervical cancer detection; however, more reliable methylation markers are needed. To identify new hypermethylated genes in the discovery phase, we compared the methylome between a pool of DNA from normal cervical epithelium (n = 19) and a pool of DNA from cervical cancer tissues (n = 38) using a methylation bead array. We integrated the differentially methylated genes with public gene expression databases, which resulted in 91 candidate genes. Based on gene expression after demethylation treatment in cell lines, we confirmed 61 genes for further validation. In the validation phase, quantitative MSP and bisulfite pyrosequencing were used to examine their methylation level in an independent set of clinical samples. Fourteen genes, including ADRA1D, AJAP1, COL6A2, EDN3, EPO, HS3ST2, MAGI2, POU4F3, PTGDR, SOX8, SOX17, ST6GAL2, SYT9, and ZNF614, were significantly hypermethylated in CIN3+ lesions. The sensitivity, specificity, and accuracy of POU4F3 for detecting CIN3+ lesions were 0.88, 0.82, and 0.85, respectively. A bioinformatics function analysis revealed that AJAP1, EDN3, EPO, MAGI2, and SOX17 were potentially implicated in β-catenin signaling, suggesting the epigenetic dysregulation of this signaling pathway during cervical cancer development. The concurrent methylation of multiple genes in cancers and in subsets of precancerous lesions suggests the presence of a driver of methylation phenotype in cervical carcinogenesis. Further validation of these new genes as biomarkers for cervical cancer screening in a larger population-based study is warranted.
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Affiliation(s)
- Yu-Chih Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Bukhari MH, Saba K, Qamar S, Majeed MM, Niazi S, Naeem S. Clinicopathological importance of Papanicolaou smears for the diagnosis of premalignant and malignant lesions of the cervix. J Cytol 2013; 29:20-5. [PMID: 22438612 PMCID: PMC3307446 DOI: 10.4103/0970-9371.93213] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Premalignant and malignant lesions are not uncommon in Pakistani women, especially in the older age-groups Aim: This study was conducted to determine the clinicopathological importance of conventional Papanicolaou (Pap) smears for the diagnosis of premalignant and malignant lesions of the cervix. Materials and Methods: Pap smears of 1000 women were examined from January 2007 to June 2009. Only cases with neoplastic cytology were included. Results: The overall frequency of normal, inadequate, neoplastic, and infective smears was 50%, 1.8%, 10.2%, and 38.3%, respectively. Most of the patients (67%) were in the postmenopausal age-group, with the mean age being 44.7±15.63 years. The commonest clinical signs/symptoms seen among the 102 patients with neoplastic gynecological lesions were vaginal discharge and abnormal bleeding (93/102;(91.2% and 62/102;60.7%). Of the 102 cases with neoplastic lesions 46 patients (45%) had low-grade squamous cell intraepithelial lesions (LSILs), 22 (21.5%) had high-grade squamous cell intraepithelial lesions (HSILs), 14 (13.7%) had squamous cell carcinoma, and 6 (5.8%) showed features of adenocarcinoma. Ten (9.8%) cases showed cytology of atypical squamous cells of undetermined significance (ASCUS) and four (3.9%) cases had atypical glandular cells of undetermined significance (AGUS). Conclusion: We conclude that cervical smear examination is well suited for diagnosing neoplastic disease. It is clear that cervical neoplastic lesions are becoming a problem in Pakistan.
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Aboul-Fotouh MEM, Hana IT. Clinical validation of high risk HPV DNA testing versus ThinPrep cytology for primary cervical cancer screening. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
ObjectiveTo investigate the clinical significance of abnormal human telomerase RNA gene component (hTERC) gene amplification tested by fluorescence in situ hybridization in cervical lesions.MethodsIn 373 patients with cytologic abnormalities, high-risk human papilomavirus (HR-HPV) was detected by the hybrid capture II method, and abnormal amplification of the hTERC gene in exfoliated cells was detected by fluorescence in situ hybridization.ResultsCell smear findings suggested atypical squamous cells in 148 patients, low-grade squamous intraepithelial lesion in 62 patients, and high-grade squamous intraepithelial lesion in 107 patients, squamous cell carcinoma in 56 patients, and cervical biopsy-revealed inflammation in 89 patients, cervical intraepithelial neoplasia (CIN) I in 36 patients, CIN II in 43 patients, CIN III in 129 patients, and infiltrating carcinoma in 76 patients. In the inflammation, CIN I, CIN II, CIN III, and infiltrating carcinoma groups, the infection rates of HR-HPV were 29.21%, 52.78%, 74.42%, 92.25%, and 93.42% (P < 0.01), respectively; the positive rates of hTERC gene amplification were 0.00%, 13.89%, 41.86%, 78.29%, and 89.47% (P < 0.01), respectively. With respect to advanced cervical lesions (≥CIN II), cytology (≥ low-grade squamous intraepithelial lesion), HR-HPV testing, and hTERC testing differed insignificantly in the negative predictive value (P > 0.05), but they differed significantly in the sensitivity, specificity, and positive predictive value (P < 0.01). Among the 3 methods, hTERC testing showed the highest specificity and positive predictive value, and HR-HPV testing showed the highest sensitivity. In 41 patients with untreated CIN I and CIN II, the sensitivity of detection of hTERC gene amplification to predict lesion progression was 88.89%, and the specificity was 93.75%.ConclusionDetection of abnormal amplification of the hTERC gene can assist in screening cervical lesions and identifying CIN I/II patients with a high progression risk.
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Lee JK, Hong JH, Kang S, Kim DY, Kim BG, Kim SH, Kim YM, Kim JW, Kim JH, Kim TJ, Kim HJ, Kim HS, Ryu HS, Song JY, Ahn HS, Yoo CW, Yoon HK, Lee KH, Lee A, Lee Y, Lee IH, Lee JW, Lee TS, Lim MC, Chang SJ, Chung HH, Ju W, Joo HJ, Hur SY, Hong SR, Nam JH. Practice guidelines for the early detection of cervical cancer in Korea: Korean Society of Gynecologic Oncology and the Korean Society for Cytopathology 2012 edition. J Gynecol Oncol 2013; 24:186-203. [PMID: 23653837 PMCID: PMC3644696 DOI: 10.3802/jgo.2013.24.2.186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/28/2013] [Accepted: 03/03/2013] [Indexed: 11/30/2022] Open
Abstract
The consensus guideline development committee of Korean Society of Gynecologic Oncology was reconvened in March 2012. The committee consisted of 36 experts representing 12 university hospitals and professional organizations. The objective of this committee was to develop standardized guidelines for cervical cancer screening tests for Korean women and to distribute these guidelines to every clinician, eventually improving the quality of medical care. Since the establishment of the consensus guideline development committee, evidence-based guidelines have either been developed de novo considering specific Korean situations or by adaptation of preexisting consensus guidelines from other countries. Recommendations for cervical cancer screening tests, management of atypical squamous and glandular cells, and management of low-grade and high-grade squamous intraepithelial lesions were developed. Additionally, recommendations for human papillomavirus DNA testing and recommendations for adolescent and pregnant women with abnormal cervical screening test results were also included.
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Affiliation(s)
- Jae Kwan Lee
- Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sokbom Kang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae-Yeon Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Hoon Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Man Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Jin Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Institute for Evidence-Based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Sun Kim
- Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Hee-Sug Ryu
- Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyeong Sik Ahn
- Institute for Evidence-Based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chong Woo Yoo
- Department of Pathology, Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hye-Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Keun-Ho Lee
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ahwon Lee
- Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yonghee Lee
- Department of Pathology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - In Ho Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Woong Ju
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Jae Joo
- Department of Pathology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Soo-Young Hur
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung-Ran Hong
- Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Joo-Hyun Nam
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Arbyn M, Roelens J, Simoens C, Buntinx F, Paraskevaidis E, Martin-Hirsch PPL, Prendiville WJ. Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions. Cochrane Database Syst Rev 2013; 2013:CD008054. [PMID: 23543559 PMCID: PMC6457841 DOI: 10.1002/14651858.cd008054.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intra-epithelial lesions (LSIL) are minor lesions of the cervical epithelium, detectable by cytological examination of cells collected from the surface of the cervix of a woman.Usually, women with ASCUS and LSIL do not have cervical (pre-) cancer, however a substantial proportion of them do have underlying high-grade cervical intra-epithelial neoplasia (CIN, grade 2 or 3) and so are at increased risk for developing cervical cancer. Therefore, accurate triage of women with ASCUS or LSIL is required to identify those who need further management.This review evaluates two ways to triage women with ASCUS or LSIL: repeating the cytological test, and DNA testing for high-risk types of the human papillomavirus (hrHPV) - the main causal factor of cervical cancer. OBJECTIVES Main objective To compare the accuracy of hrHPV testing with the Hybrid Capture 2 (HC2) assay against that of repeat cytology for detection of underlying cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) or grade 3 or worse (CIN3+) in women with ASCUS or LSIL. For the HC2 assay, a positive result was defined as proposed by the manufacturer. For repeat cytology, different cut-offs were used to define positivity: Atypical squamous cells of undetermined significance or worse (ASCUS+), low-grade squamous intra-epithelial lesions or worse (LSIL+) or high-grade squamous intra-epithelial lesions or worse (HSIL+).Secondary objective To assess the accuracy of the HC2 assay to detect CIN2+ or CIN3+ in women with ASCUS or LSIL in a larger group of reports of studies that applied hrHPV testing and the reference standard (coloscopy and biopsy), irrespective whether or not repeat cytology was done. SEARCH METHODS We made a comprehensive literature search that included the Cochrane Register of Diagnostic Test Accuracy Studies; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (through PubMed), and EMBASE (last search 6 January 2011). Selected journals likely to contain relevant papers were handsearched from 1992 to 2010 (December). We also searched CERVIX, the bibliographic database of the Unit of Cancer Epidemiology at the Scientific Institute of Public Health (Brussels, Belgium) which contains more than 20,000 references on cervical cancer.More recent searches, up to December 2012, targeted reports on the accuracy of triage of ASCUS or LSIL with other HPV DNA assays, or HPV RNA assays and other molecular markers. These searches will be used for new Cochrane reviews as well as for updates of the current review. SELECTION CRITERIA Studies eligible for inclusion in the review had to include: women presenting with a cervical cytology result of ASCUS or LSIL, who had undergone both HC2 testing and repeat cytology, or HC2 testing alone, and were subsequently subjected to reference standard verification with colposcopy and colposcopy-directed biopsies for histologic verification. DATA COLLECTION AND ANALYSIS The review authors independently extracted data from the selected studies, and obtained additional data from report authors.Two groups of meta-analyses were performed: group I concerned triage of women with ASCUS, group II concerned women with LSIL. The bivariate model (METADAS-macro in SAS) was used to assess the absolute accuracy of the triage tests in both groups as well as the differences in accuracy between the triage tests. MAIN RESULTS The pooled sensitivity of HC2 was significantly higher than that of repeat cytology at cut-off ASCUS+ to detect CIN2+ in both triage of ASCUS and LSIL (relative sensitivity of 1.27 (95% CI 1.16 to 1.39; P value < 0.0001) and 1.23 (95% CI 1.06 to 1.4; P value 0.007), respectively. In ASCUS triage, the pooled specificity of the triage methods did not differ significantly from each other (relative specificity: 0.99 (95% CI 0.97 to 1.03; P value 0.98)). However, the specificity of HC2 was substantially, and significantly, lower than that of repeat cytology in the triage of LSIL (relative specificity: 0.66 (95% CI 0.58 to 0.75) P value < 0.0001). AUTHORS' CONCLUSIONS HPV-triage with HC2 can be recommended to triage women with ASCUS because it has higher accuracy (significantly higher sensitivity, and similar specificity) than repeat cytology. When triaging women with LSIL, an HC2 test yields a significantly higher sensitivity, but a significantly lower specificity, compared to a repeat cytology. Therefore, practice recommendations for management of women with LSIL should be balanced, taking local circumstances into account.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.
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de Blasio BF, Neilson AR, Klemp M, Skjeldestad FE. Modeling the impact of screening policy and screening compliance on incidence and mortality of cervical cancer in the post-HPV vaccination era. J Public Health (Oxf) 2012; 34:539-47. [PMID: 22707556 DOI: 10.1093/pubmed/fds040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Norway, pap smear screening target women aged 25-69 years on a triennial basis. The introduction of human papillomavirus (HPV) mass immunization in 2009 raises questions regarding the cost-saving future changes to current screening strategies. METHODS We calibrated a dynamic HPV transmission model to Norwegian data and assessed the impact of changing screening 20 or 30 years after vaccine introduction, assuming 60 or 90% vaccination coverage. Screening compliance among vaccinated women was assumed at 80 or 50%. Strategies considered: (i) 5-yearly screening of women of 25-69 years, (ii) 3-yearly screening of women of 30-69 years and (iii) 3-yearly screening of women of 25-59 years. RESULTS Greatest health gains were accomplished by ensuring a high vaccine uptake. In 2060, cervical cancer incidence was reduced by an estimated 36-57% compared with that of no vaccination. Stopping screening at the age of 60 years, excluding opportunistic screening, increased cervical cancer incidence by 3% (2060) compared with maintaining the current screening strategy, resulting in 1.0-2.4% extra cancers (2010-2060). The 5-yearly screening strategy elevated cervical cancer incidence by 30% resulting in 4.7-11.3% additional cancers. CONCLUSION High vaccine uptake in the years to come is of primary concern. Screening of young women <30 years remains important, even under the conditions of high vaccine coverage.
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Affiliation(s)
- Birgitte Freiesleben de Blasio
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern 0317, Oslo, Norway.
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Neumeyer-Gromen A, Bodemer N, Müller SM, Gigerenzer G. [Do media reports and public brochures facilitate informed decision making about cervical cancer prevention?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 54:1197-210. [PMID: 22015792 DOI: 10.1007/s00103-011-1347-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
With the introduction and recommendation of the new HPV (human papillomavirus) vaccination in 2007, cervical cancer prevention has evoked large public interest. Is the public able to make informed decisions on the basis of media reports and brochures? To answer this question, an analysis of media coverage of HPV vaccination (Gardasil®) and Pap (Papanicolaou) screening was conducted from 2007-2009, which investigated the minimum requirement of completeness (pros and cons), transparency (absolute numbers), and correctness (references concerning outcome, uncertainty, magnitude) of the information. As a bench mark, facts boxes with concise data on epidemiology, etiology, benefits, harms, and costs were compiled in advance. Although all vaccination reports and brochures covered the impact of prevention, only 41% provided concrete numbers on effectiveness (90/220) and 2% on absolute risk reductions for the cancer surrogate dysplasia (5/220), whereby none of the latter numbers was correct. The prevention potential was correctly presented once. Only 48% (105/220) mentioned pros and cons. With regard to screening, 20% (4/20) provided explicit data on test quality and one expressed these in absolute numbers, while 25% (5/20) reported the prevention potential; all given numbers were correct. Finally, 25% (5/20) mentioned the possibility of false positive results. Minimum requirements were fulfilled by 1/220 vaccination and 1/20 screening reports. At present, informed decision making based on media coverage is hardly possible.
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Affiliation(s)
- A Neumeyer-Gromen
- Max-Planck-Institut für Bildungsforschung, Harding Center for Risk Literacy, Lentzeallee 94, 14195, Berlin, Deutschland.
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Dobec M, Bannwart F, Kilgus S, Kaeppeli F, Cassinotti P. Human papillomavirus infection among women with cytological abnormalities in Switzerland investigated by an automated linear array genotyping test. J Med Virol 2011; 83:1370-6. [PMID: 21678440 DOI: 10.1002/jmv.22126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Limited data are available describing human papillomavirus (HPV) genotype distribution among females with cytological abnormalities in Switzerland. Cervical cell specimens obtained from 5,318 women were screened routinely by liquid-based Pap smear. All specimens with cellular abnormalities were analyzed subsequently for HPV DNA by the Linear Array HPV genotyping test. Cellular abnormalities were found in 202 (3.8%) specimens, of which 150 (74.3%) were positive for high-risk (HR) HPV. HR-HPV was detected in 20 (60.6%; 95% CI, 43.7-75.4%) of 33 specimens with atypical squamous cells of undetermined significance compared to 98 (72.1%; 95% CI, 64-78.9%) of 136 low-grade squamous intraepithelial lesions and 32 (97%; 95% CI, 83.4-99.9%) of 33 high-grade squamous intraepithelial lesions. The cumulative prevalence of HR-HPV other than HPV 16 and 18 was significantly higher than HPV 16 and/or 18 lesions with atypical squamous cells and low-grade lesions and was comparable in high-grade squamous intraepithelial lesions. The most common HR-HPV genotypes were HPV 16 (15.2%), HPV 31 (12.1%), HPV 58 (12.1%), HPV 51 (9.1%), and HPV 59 (9.1%) in women with atypical squamous cells, HPV 16 (25%), HPV 51 (16.9%), HPV 52 (11.8%), HPV 31 (9.6%), and HPV 56 (8.1%) in women with low-grade lesions (LSIL) and HPV 16 (57.6%), HPV 18 (18.2%), HPV 31 (15.2%), HPV 52 (12.1%), and HPV 58 (6.1%) in women with high-grade lesions (HSIL).
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Affiliation(s)
- Marinko Dobec
- Medica, Medizinische Laboratorien Dr. F. Kaeppeli, Zurich, Switzerland.
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García-Arteaga JD, Kybic J, Li W. Automatic colposcopy video tissue classification using higher order entropy-based image registration. Comput Biol Med 2011; 41:960-70. [PMID: 21890126 DOI: 10.1016/j.compbiomed.2011.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 02/28/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
Abstract
Colposcopy is a well-established method to detect and diagnose intraepithelial lesions and uterine cervical cancer in early stages. During the exam color and texture changes are induced by the application of a contrast agent (e.g.3-5% acetic acid solution or iodine). Our aim is to densely quantify the change in the acetowhite decay level for a sequence of images captured during a colposcopy exam to help the physician in his diagnosis providing new tools that overcome subjectivity and improve reproducibility. As the change in acetowhite decay level must be calculated from the same tissue point in all images, we present an elastic image registration scheme able to compensate patient, camera and tissue movement robustly in cervical images. The image registration is based on a novel multi-feature entropy similarity criterion. Temporal features are then extracted using the color properties of the aligned image sequence and a dual compartment tissue model of the cervix. An example of the use of the temporal features for pixel-wise classification is presented and the results are compared against ground truth histopathological annotations.
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Affiliation(s)
- Juan D García-Arteaga
- Center for Machine Perception, Czech Technical University, Department of Cybernetics, Faculty of Electrical Engineering, Prague, Czech Republic.
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Bukhari MH, Majeed M, Qamar S, Niazi S, Syed SZ, Yusuf AW, Yusuf NW. Clinicopathological study of Papanicolaou (Pap) smears for diagnosing of cervical infections. Diagn Cytopathol 2010; 40:35-41. [PMID: 20949462 DOI: 10.1002/dc.21498] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 06/11/2010] [Indexed: 11/07/2022]
Abstract
Cervical infections are not uncommon in our population especially in young and sexually active women. One thousand samples of married women, aged between 20 and 70 years, were studied by conventional Papanicolaou smears. These samples were examined in the Department of Pathology, King Edward Medical University, Lahore from January 2007 to June 2009. Only cases without (pre)neoplastic cytology were included. Six types of infections were diagnosed cytologically. The overall frequency of normal, inadequate, neoplastic, and infective smears was 50%, 1.8%, 10.2%, and 38.3%, respectively. Most of the patients (67%) were in the reproductive age group with mean age 34.7 ± 2.6 years. The commonest clinical sign seen in 354/383 (92%) cases and symptom in (349/383; 91%) cases were vaginal discharge and pruritis vulvae. Among the infective smears, 290 cases (75.7%), the cytologic diagnosis was nonspecific inflammation. Most of these 290 smears contained clue cells (indicating Gardnerella infection) and a lack of lactobacilli. Such smears are predominant in patients suffering from bacterial vaginosis (BV). Twenty-eight smears (7.3%) were positive for Trichomonas vaginalis, 27 cases (7%) were smears with koilocytic change pathognomonic of human papilloma virus infection. Twenty-five smears (6.5%) were positive for fungal infection. Seven cases (1.8%) were diagnosed as herpes simplex virus infection. Finally, there were six cases (1.5%) with atrophic vaginitis. We conclude that the cervical smear is well suited for diagnosing cervical infections. It is clear that Gardnerella, known to be associated with bacterial vaginosis, is a major problem in our Pakistani population.
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Does acetic acid influence the non-dysplastic Pap smear? Arch Gynecol Obstet 2010; 283:1309-12. [PMID: 20552209 DOI: 10.1007/s00404-010-1556-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 06/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Acetic acid tests are commonly performed for colposcopic evaluation of the cervix. However, it is unclear whether the acetic acid influences normal Papanicolaou (Pap) smear results. METHODS Patients were routinely seen in our outpatient department between April and May 2009. Two Pap smears were performed in 50 patients. One smear was done before, the other after the acetic acid test. The smears were evaluated by an experienced cytologist. He did not know whether the smear was done with or without acetic acid. RESULTS In a normal smear, there was no influence of acetic acid on the cytologic result. In two patients, a smear of Pap III [Bethesda, atypical squamous cells of undetermined significance (ASCUS)] was seen before acetic acid test. This changed to Pap IIID [Bethesda, low-grade squamous epithelial lesions (LSIL)] after acetic acid test. CONCLUSIONS The acetic acid test does not seem to alter the result of the non-dysplastic smear. In contrast to this, a dysplastic smear seems to be influenced by the acetic acid. This should be evaluated in a further investigation.
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Nocon M, Roll S, Mittendorf T, von der Schulenburg JM, Willich SN. [Human papilloma virus (HPV) testing for cervical carcinoma screening]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2010; 104:138-42. [PMID: 20441022 DOI: 10.1016/j.zefq.2008.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cytology-based screening for cervical cancer has been criticised because of its high percentage of false-negative results. Considering HPV testing as an integral part of the screening process has been discussed as a way to address this issue in Germany. The aim of our study was to review trials comparing HPV testing with cytology in cervical cancer screening. Based on a systematic literature review, 14 studies with 85,820 women could be included. Generally HPV testing was more sensitive, but less specific than cytology. Based on the pooled data, sensitivity and specificity for HPV testing were 91% and 90%, respectively, whereas sensitivity and specificity for cytology amounted to 66% and 96%, respectively. Based on these results, including HPV testing in primary cervical cancer screening might lead to a reduction of false-negative results. Due the lower specificity false-positive test results would increase though.
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Affiliation(s)
- Marc Nocon
- Institut für Sozialmedizin, Epidemiologie, und Gesundheitsökonomie, Charité Universitätsmedizin Berlin.
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HPV-vaccination for the prevention of cervical cancer in Austria: a model based long-term prognosis of cancer epidemiology. J Public Health (Oxf) 2009. [DOI: 10.1007/s10389-009-0276-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Insinga RP, Dasbach EJ, Elbasha EH. Epidemiologic natural history and clinical management of Human Papillomavirus (HPV) Disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model. BMC Infect Dis 2009; 9:119. [PMID: 19640281 PMCID: PMC2728100 DOI: 10.1186/1471-2334-9-119] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 07/29/2009] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Natural history models of human papillomavirus (HPV) infection and disease have been used in a number of policy evaluations of technologies to prevent and screen for HPV disease (e.g., cervical cancer, anogenital warts), sometimes with wide variation in values for epidemiologic and clinical inputs. The objectives of this study are to: (1) Provide an updated critical and systematic review of the evidence base to support epidemiologic and clinical modeling of key HPV disease-related parameters in the context of an HPV multi-type disease transmission model which we have applied within a U.S. population context; (2) Identify areas where additional studies are particularly needed. METHODS Consistent with our and other prior HPV natural history models, the literature review was confined to cervical disease and genital warts. Between October 2005 and January 2006, data were gathered from the published English language medical literature through a search of the PubMed database and references were examined from prior HPV natural history models and review papers. Study design and data quality from individual studies were compared and analyses meeting pre-defined criteria were selected. RESULTS Published data meeting review eligibility criteria were most plentiful for natural history parameters relating to the progression and regression of cervical intraepithelial neoplasia (CIN) without HPV typing, and data concerning the natural history of HPV disease due to specific HPV types were often lacking. Epidemiologic evidence to support age-dependency in the risk of progression and regression of HPV disease was found to be weak, and an alternative hypothesis concerning the time-dependence of transition rates is explored. No data were found on the duration of immunity following HPV infection. In the area of clinical management, data were observed to be lacking on the proportion of clinically manifest anogenital warts that are treated and the proportion of cervical cancer cases that become symptomatic by stage. CONCLUSION Knowledge of the natural history of HPV disease has been considerably enhanced over the past two decades, through the publication of an increasing number of relevant studies. However, considerable opportunity remains for advancing our understanding of HPV natural history and the quality of associated models, particularly with respect to examining HPV age- and type-specific outcomes, and acquired immunity following infection.
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Affiliation(s)
- Ralph P Insinga
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA, USA
| | - Erik J Dasbach
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA, USA
| | - Elamin H Elbasha
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA, USA
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Abstract
OBJECTIVE To estimate the cost effectiveness of alternative methods of managing low grade cervical cytological abnormalities detected at routine screening. Design Cost analysis within multicentre individually randomised controlled trial. SETTING Grampian, Tayside, and Nottingham. PARTICIPANTS 4201 women with low grade abnormalities. INTERVENTIONS Cytological surveillance or referral to colposcopy for biopsy and recall if necessary or referral to colposcopy with immediate treatment based on colposcopic appearance. MAIN OUTCOME MEASURES Data on resource use collected from participants throughout the duration of the trial (36 months), enabling the estimation of both the direct (health care) and indirect (time and travel) costs of management. Quality of life assessed at recruitment and at 12, 18, 24, and 30 months, using the EQ-5D instrument. Economic outcomes expressed as costs per case of cervical intraepithelial neoplasia (grade II or worse) detected, by trial arm, as confirmed at exit, and cost utility ratios (cost per quality adjusted life year (QALY) gained) for the three pairwise comparisons of trial arms. RESULTS The mean three year discounted costs of surveillance, immediate treatment, and biopsy and recall were pound150.20 (euro177, $249), pound240.30 (euro283, $415), and pound241.10 (euro284, $4000), respectively, viewed from the health service perspective. From the social perspective, mean discounted costs were pound204.40 (euro241, $339), pound339.90 (euro440, $563), and pound327.50 (euro386, $543), respectively. Estimated at the means, the incremental cost effectiveness ratios indicated that immediate treatment was dominated by the other two management methods, although it did offer the lowest cost per case of cervical intraepithelial neoplasia detected and treated. The pronounced skews in the distributions indicated that probabilistic uncertainty analysis would offer more meaningful estimates of cost effectiveness. The observed differences in the cost effectiveness ratios between trial arms were not significant. CONCLUSION Judged within the time frame of the TOMBOLA evaluation, there is no compelling economic reason to favour any one follow-up method over either of the others. TRIAL REGISTRATION ISRCTN 34841617.
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Aslam MI, Taylor K, Pringle JH, Jameson JS. MicroRNAs are novel biomarkers of colorectal cancer. Br J Surg 2009; 96:702-10. [PMID: 19526617 DOI: 10.1002/bjs.6628] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recent studies have identified unique small ribonucleic acids called microRNAs (miRNAs) in colonic tumour tissue and blood that may accurately diagnose the presence of colorectal cancer and help predict disease recurrence. This review explores the potential role of these biomarkers. METHODS A literature search identified studies describing miRNAs in colorectal cancers. The outcomes of interest included diagnosis, progression and recurrence of disease, and future therapy. RESULTS Overexpression and silencing of specific miRNAs are associated with the development and progression of colorectal cancer. Such a role in oncogenesis suggest that miRNAs may be important targets for gene therapies. Differential expression of specific miRNAs in tissues and blood offers the prospect of their use in early detection and screening for colorectal cancer. MiRNAs are implicated in metastasis and cytotoxic drug resistance. Their manipulation has potential in both prevention of recurrence and palliation. CONCLUSION The miRNAs expression profile in tissue and blood has potential for their use in the detection, screening and surveillance of colorectal cancer. Furthermore, miRNAs may be targeted by gene therapy to treat colorectal cancer.
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Affiliation(s)
- M I Aslam
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK.
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Ahmed HG, Edris AM, Mohmed EA, Hussein MOM. Value of centrifugated liquid-based cytology by Papanicolaou and May-Grünwald in oral epithelial cells. Rare Tumors 2009; 1:e12. [PMID: 21139883 PMCID: PMC2994426 DOI: 10.4081/rt.2009.e12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 06/30/2009] [Indexed: 11/23/2022] Open
Abstract
For many years, liquid-based cytology (LBC) has been developed for cervical cancer screening and not oral cancer, as it requires automated devices. The aim of this study was to compare the utility of centrifugated CLBC preparation with that of direct preparation in oral lesions, by Papanicolaou (Pap) and May Grünwald-Giemsa's (MGG) methods. A total of 100 consecutive cases of oral lesions were investigated. We compared the results obtained by the CLBC performed by cytocentrifugation with those obtained by direct smear applying Pap and MGG methods. The comparison between CLBC and direct smears was based on the thickening or adequacy of the smear, distribution of cells and staining quality. All smears in CLBC and direct preparation were found adequate. For thickness of the smear, 40% and 42% were excellent, 33% and 30% were good, and 27% and 28% were acceptable by LBC and direct preparation, respectively. For the distribution of cells and scantiness of background elements, 92 (92%) smears of the CLBC have revealed clear, well distributed smears, compared to 70 (70%) of those in direct preparation. For the staining quality with the Pap method, 39% and 69% were excellent staining quality, 25% and 20% were good, and 36% and 11% were acceptable for CLBC and direct preparation, respectively. In MGG method, 9% and 22% were excellent staining quality, 23% and 36% were good and 68% and 43% were acceptable for CLBC and direct preparation respectively. CLBC performed by cytocentrifugation is inexpensive, and reduces inadequate smears and background staining.
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Affiliation(s)
- Hussain Gadelkarim Ahmed
- Department of Histopathology and Cytology, Faculty of Medical Laboratory Sciences, Khartoum, Sudan
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Elbasha EH, Dasbach EJ, Insinga RP, Haupt RM, Barr E. Age-based programs for vaccination against HPV. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:697-707. [PMID: 19490561 DOI: 10.1111/j.1524-4733.2009.00512.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The risk of infection with human papillomavirus (HPV) increases with age. Answering the question of which age groups are appropriate to target for catch-up vaccination with the newly licensed quadrivalent HPV vaccine (types 6/11/16/18) will be important for developing vaccine policy recommendations. OBJECTIVES To assess the value of varying female HPV vaccination strategies by specific age groups of a catch-up program in the United States. METHODS The authors used previously published mathematical population dynamic model and cost-utility analysis to evaluate the public health impact and cost-effectiveness of alternative quadrivalent HPV (6/11/16/18) vaccination strategies. The model simulates heterosexual transmission of HPV infection and occurrence of cervical intraepithelial neoplasia (CIN), cervical cancer, and external genital warts in an age-structured population stratified by sex and sexual activity groups. The cost-utility analysis estimates the cost of vaccination, screening, diagnosis, and treatment of HPV diseases, and quality-adjusted survival. RESULTS Compared with the current screening practices, vaccinating girls and women ages 12 to 24 years was the most effective strategy, reducing the number of HPV6/11/16/18-related genital warts, CIN grades 2 and 3, and cervical cancer cases among women in the next 25 years by 3,049,285, 1,399,935, and 30,021; respectively. The incremental cost-effectiveness ratio of this strategy when compared with vaccinating girls and women ages 12 to 19 years was $10,986 per quality-adjusted life-year gained. CONCLUSION;: Relative to other commonly accepted health-care programs, vaccinating girls and women ages 12 to 24 years appears cost-effective.
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Affiliation(s)
- Elamin H Elbasha
- Merck Research Laboratories, Merck & Co., Inc., NorthWales, PA, USA.
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